Barcodes are a proven technology for reducing medication administration errors, while RFID tags show promise for tracking of assets as well as personnel and patients. Yet implementation has been slow, as hospitals struggle with cost and complexity issues.
Hospitals are an ideal environment for barcodes and radio-frequency identification (RFID) tags, where they have been applied successfully in a number of applications. As many hospitals have demonstrated, the use of barcoding, when combined with patient-safety best practices, is a proven, and relatively inexpensive, preventative measure to prevent medication administration errors at the point of care. RFID, while earlier in the curve than barcodes, has shown promise in asset tracking.
But implementation of both technologies in healthcare has been relatively slow, as hospitals deal with budgetary issues as well as those of complexity. As noted by Jared Rhoads, senior research analyst for emerging practices at the Falls Church, Va.-based CSC, competing demands on hospitals faced with complaining with meaningful use could continue to hobble the uptake of promising tracking technologies.
One of the interesting possibilities in the implementation of barcoding-facilitated medication administration is that the barcodes can be linked to a decision support system, according to Rhoads. It can check to see if the medication is appropriate to someone of that weight, and if the patient's weight is stored in the system, you can do checking that adds more value, he says.
THE RIGHT MEDICATIONS
Nonetheless, some experts say the technologies bear looking into, particularly in the area of medication administration. One proponent is Mark Neuenschwander, president of The Neuenschwander Company, a Bellevue, Wash. consultancy, and an expert in drug dispensing automation and point-of-care barcoding systems. He has been an active supporter of the use of barcodes in patient safety for nearly 20 years.
Neuenschwander notes that barcodes are a key way to ensure proper patient identification at the bedside. “Barcodes do not replace human interaction with the patient,” he says, “but they are a redundant identifier that is more fail-safe than any other approach,” he says.
He estimates that 35 percent of hospitals in the U.S. now scan medications at the point of care, up from 3 percent of hospitals doing so in 2001. This is a significant increase, but still far from pervasive, he says. In other applications, the use of barcodes has been spotty. Neuenschwander estimates that less than one-third of hospitals use barcodes in transfusions. And while barcodes are used to track specimens in labs, they are not necessarily used to scan at each step in the entire process, from the time the sample is taken from the patient, he says. “Everything starts with knowing who you are with, the right patient,” he says.
Over the last 10 years, considerable groundwork has been laid for the use of barcodes on medications, according to Neuenschwander, setting the stage for wider use of barcodes at the point of care. He estimates that only 30 to 35 percent of medication packages had barcodes in 2001. At the time, he says, hospitals were open to the use of barcodes, but most medications still lacked them, and vendors and drug manufacturers saw little motivation to put barcodes on products because there was little scanning activity by hospitals. In 2004 the Food and Drug Administration (FDA) broke the logjam by requiring barcodes on human drugs and biological products. Today, virtually all medications at the point of care have barcodes, he says.
Neuenschwander is careful to make the distinction that the FDA mandate for barcodes on drug packaging is not a requirement for its use at the bedside. “There's pushback,” he says. “Everybody might believe in it, but nobody feels like hospitals should be forced to do it. Hospitals are already suffering from costs.” He believes that, more likely, barcodes increasingly will be viewed as a de facto best practice. “It will be self-imposed, not regulated,” he says.
Interestingly, Neuenschwander says, barcodes per se are not mentioned under meaningful use, although seven of 15 measures of first round meaningful use requirements include medication reporting in the electronic medical record (EMR). As an example of the gaps that still exist, he notes that it is possible to use electronic medication administration record (eMAR) without barcoding, and enter the medication administration information on a computer that is not at the point of care.